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Aetna Medicare FL Explorer Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare FL Explorer Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare FL Explorer Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare FL Explorer Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South FL, Treasure Coast FL. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare FL Explorer Premier (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare FL Explorer Premier (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare FL Explorer Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare FL Explorer Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your medications depending on the drug tier and pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies or through mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 22% or 25% coinsurance depending on the drug tier and pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare FL Explorer Premier (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services and many preventive services have no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and maximum benefits. Additional benefits include coverage for ambulance services, emergency services, and various therapies with copays or coinsurance. Home health and skilled nursing facility services are covered with specific copays, and the plan also covers home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $350 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $286 for days 1-8 and no copay for days 9-90 for Inpatient Hospital Psychiatric; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a $350 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a $60 copay for both Individual and Group Sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare FL Explorer Premier (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $290 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers primary care services with a $5 copay, chiropractic services with a $20 copay, occupational therapy with a $45 copay, and specialist services with a $50 copay. Mental health specialty services and psychiatric services, including individual and group sessions, have a $60 copay. Physical therapy and speech-language pathology services have a $65 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $65, and opioid treatment program services have a $60 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney disease education services have a 20% coinsurance, while other preventive services have no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1,700, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare FL Explorer Premier (PPO) plan. Routine eye exams have no copay, while other eye exams may have a copay between $0 and $50. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $170 every year.
Dental Services See details
Dental services are covered, with a $1,000 annual maximum benefit for both in-network and out-of-network services. Medicare Dental Services have a $50 copay and require prior authorization, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 25%, and no copay. Prosthetic Devices have a 25% coinsurance. Medical Supplies have a coinsurance between 0% and 25%, and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $230, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other services include Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $30 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other 1 and Other 2 services are covered with no copay.
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